Obesity: The Disease that Keeps on Growing

A number of studies have shown that individuals who are obese are often stereotyped as “lazy” or “lacking in willpower.” However, obesity is no longer considered a cosmetic issue that is caused by overeating and a lack of self-control. The World Health Organization (W.H.O.), along with National and International medical and scientific societies, now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

In the United States, epidemiological data from a study that measured the actual body size of thousands of Americans, showed that 34 percent of adults more than 20 years old are affected by obesity and 68 percent are overweight (2007-2008 data). Obesity affected 10 percent of children between two and five years of age, 2 percent of those between 6 to 11 years old, and 18 percent of adolescents.

Throughout the last 3 decades, the prevalence of obesity has been increasing at an alarming rate. Since 1985, the Center for Disease Control (CDC) has supported an ongoing study, conducted on a yearly basis by state health departments, to examine changes in obesity prevalence state-to-state, and has found the following:

  • In 1990, the obesity prevalence for most of the states was 10 percent or less.
  • By 1995, more than half the states had a prevalence of 15 percent.
  • By 2000, nearly half the states had a prevalence of 20 percent or higher.
  • Five years later (2005), all but three states had a prevalence greater than 20 percent and nearly a third had a prevalence of 25 percent or more.
  • By 2010, the data show that most of U.S. states had a prevalence of 25 percent and many had a prevalence of 30 percent or higher.

Obesity is considered a multifactorial disease with a strong genetic component. Acting upon a genetic background are a number of hormonal, metabolic, psychological, cultural and behavioral factors that promote fat accumulation and weight gain.

Many other conditions associated with obesity contribute to the progression of the AdobeStock_69574863 (2).jpgdisease. Obesity reduces mobility and the number of calories that would be burned in the performance of activity. Weight gain may also cause psychological or emotional distress which, in turn, produces hormonal changes that may cause further weight gain by stimulating appetite and by increasing fat uptake into fat storage depots.

Sleep duration is reduced by weight gain due to a number of conditions that impair sleep quality such as pain, sleep apnea and other breathing problems, a need to urinate more frequently, use of certain medications, and altered regulation of body temperature. Shortened sleep duration, in turn, produces certain hormones that both stimulate appetite and increase the uptake of fat into fat storage depots.

Weight gain also contributes to the development of other diseases such as hypertension, diabetes, heart disease, osteoarthritis and depression, and these conditions are often treated with medications that contribute to even further weight gain. In all of these ways and more, obesity ’begets’ obesity, trapping the individual in a vicious weight gain cycle.

Multiple factors acting upon a genetic background cause weight gain and obesity. Conditions associated with weight gain and biological changes in the body that occur as a result of weight gain contribute to progression of the disease, often trapping the individual in a vicious weight gain cycle. Obesity is a complex disease influenced by several issues, including genetic, physiological, environmental, and behavioral.

If you live in the Las Vegas area and are concerned about your weight, schedule an appointment with Dr. Shawn Tsuda to learn more about how to improve your weight and health.

 

Get the Facts about Bariatric Surgery

Bariatric surgery is an option that many obesity medicine specialists say is too often ignored or dismissed. Yet it is the only option that almost always works to help very heavy people lose a lot of weight. Weight-loss surgery can also make some chronic conditions vanish entirely.

Here are some facts about bariatric surgery and what it does:

  • Twenty-four million, Americans are eligible for bariatric surgery according to the American Society for Metabolic and Bariatric Surgery. The criteria are a body mass index (BMI) above 40, or a BMI of at least 35 along with other medical conditions like diabetes, hypertension, sleep apnea, or acid reflux.
  • Fewer than 200,000 have the surgery each year.
  • There are four surgical types in use today. The two most popular procedures are the Roux-en-Y gastric bypass and the gastric sleeve. Both make the stomach smaller. The bypass also reroutes the small intestine. A simpler procedure, the gastric band, is less effective and has fallen out of favor. And a much more drastic operation, the biliopancreatic diversion with duodenal switch, which bypasses a large part of the small intestine, is rarely used because it has higher mortality and complication rates.
  • The average cost of a sleeve gastrectomy is $16,000 to $19,000, and the average cost of a gastric bypass is $20,000 to $25,000. Most insurance plans cover the cost for patients who qualify, though some plans require that patients try dieting for a certain amount of time first.
  • Bariatric surgery is not a magic bullet that will solve all of your weight-related problems. Leading a healthy lifestyle full of healthy foods and exercise post surgery is crucial.

If you live in the Las Vegas area, have a BMI above 40 or any of the other conditions mentioned above, schedule a consultation with Dr. Shawn Tsuda. He and his expert team can help you find the treatment that’s right for you.

AdobeStock_125554661.jpeg

 

Eliminate the Need for Potentially Harmful Acid Reflux Meds

Nearly 20 percent of Americans suffer from regular bouts of heartburn, acid indigestion and other symptoms of chronic gastroesophageal reflux disease (GERD). GERD is a severe, chronic acid reflux condition in which acidic stomach contents back up into your esophagus. The muscle connecting the stomach to the esophagus is weak or relaxes abnormally, allowing this abnormal movement.

Over the last 20 years, the most popular and effective GERD medications on the market, both prescription and over-the-counter, have been a class of drugs called proton pump inhibitors (PPIs). However, long-term use of PPIs have been found to harmful to the body.

Over the last few years, there have been many studies looking at whether long-term PPI use contributes to gut infections, bone loss, chronic kidney disease,  and even dementia. As a precaution, experts recommend that people who have been taking more than one PPI a day for many years seek a medical re-evaluation to see if they still need and are benefitting from the medication.

Here are a few classic symptoms of GERD to look out for:

  • Heartburn: For many people, acid indigestion (known as heartburn) is more than an occasional annoyance after eating a greasy meal. Research shows that more than 60 million people suffer from this burning sensation that can extend from the breastbone to the neck and throat. Heartburn sufferers may also experience a sore throat, hoarseness, chronic cough, asthma, or a feeling of a lump in the throat. Because there can be chest pain associated with GERD, heartburn sometimes is mistaken for heart attack.
  • Regurgitation: a sensation of acid backed up in the esophagus. Other common symptoms are: feeling that food may be trapped behind the breastbone, heartburn or a burning pain in the chest (under the breastbone), increased by bending, stooping, lying down, or eating, more likely or worse at night, relieved by antacids, nausea after eating

Untreated GERD can damage the food pipe, and contribute to Barrett’s esophagus, a risk anatomy-demon-3factor for esophageal cancer, so it’s important not to ignore.

Fortunately, there is a simple, minimally invasive laparoscopic procedure that starts to have a positive impact from day one and eliminates the need for medications for GERD.  LINX is easy to understand and love because it is a simple, quarter-sized device that does exactly what your failing Reflux Barrier is supposed to do — prevent stomach acid from entering your esophagus. LINX is designed to start working the moment the device is implanted.

If you’re interested in learning more, schedule an appointment with Dr. Shawn Tsuda. He can help you decide if LINX is a good option for you.

Fighting Type 2 Diabetes with Weight-loss Surgery

In a recent study, researchers were able to identify genetic markers that could predict the risk of type 2 diabetes (T2DM). Doctors hope that this will lead to new strategies for predicting and possibly preventing T2DM and other consequences of being overweight. These findings are particularly important, as an estimated 1.5 billion people throughout the world are overweight. Researchers hope their findings could lead to better ways at identifying those most at risk of developing diabetes and help them make changes in their lifestyles to ensure they do not go on to develop this condition.

Here are some things we know:

  • Obesity is a major independent risk factor for developing type 2 diabetes, and more than 90% of type 2 diabetics are overweight or obese.
  • Modest weight loss, as little as 5% of total body weight, can help to improve type 2 diabetes in patients who are overweight or obese.
  • Metabolic and bariatric surgery may result in resolution or improvement of type 2 diabetes independent of weight loss.

Current therapy for T2DM includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adherence to the prescribed diabetes treatment regimen may help to keep blood sugar levels from being excessively high although medications and lifestyle changes cause remission of the disease. In fact, T2DM often worsens with time, requiring even greater numbers of medication or a higher dosage to keep blood sugar under control. For this reason, T2DM has been considered a chronic and progressive disease.

Weight loss surgery may improve blood sugar control by altering levels of gut hormones, as well as by speeding up weight loss. It may also alter the balance of microbes in the digestive system in beneficial ways.

  • Studies comparing metabolic and bariatric surgery to nonsurgical treatment for obesity found surgery results in greater weight loss and higher type 2 diabetes remission rates.
  • Studies with more than six months follow up showed surgical patients lost an average of 57 more pounds than participants in nonsurgical weight loss programs, and were 22 times more likely to see their type 2 diabetes abate.
  • Head-to-head studies comparing bariatric surgery to medical therapy found bariatric surgery superior to medical treatment in producing type 2 diabetes remission, even before weight loss.
  • A Cleveland Clinic study showed within one year, diabetes remission rates with bariatric surgery were about 40% (42% gastric bypass, 37% gastric sleeve) compared to about 12% for patients treated with the best pharmacotherapy available; patients had BMI between 27 and 43.
  • Catholic University/New York-Presbyterian/Weill Cornell Medical Center showed remission rates were about 85% for bariatric surgery (75% gastric bypass, 95% Overweight Woman is Overjoyedbiliopancreatic diversion) and zero for medical therapy in patients with BMI greater than 35, after two years.
  • In surgical groups, both weight loss and preoperative BMI were not predictors of diabetes control, suggesting such surgical procedures may be independent of weight loss.
  • 73% of gastric band patients with type 2 diabetes experience remission two years after surgery, a 5 times higher resolution rate than those receiving convention therapy.
  • Conventional therapy includes access to general physician, nurse and diabetes educator, and medical therapies including pharmaceutical agents, individual lifestyle modification programs, and physical activity.

The American Diabetes Association recommends bariatric surgery be considered for adults with type 2 diabetes who have a BMI greater than 35, in particular if diabetes or associated comorbidities are difficult to control with lifestyle and pharmacologic therapy. If you live in the Las Vegas area and are considering bariatric surgery, schedule an appointment with Dr. Shawn Tsuda. He and his expert team can help find the right treatment for you.

 

 

Instead of Making Yourself Over this Year Make Over your Resolutions

The new year is here, and if you are like many, many people you’ve made resolutions about how you’re going to lose weight, exercise regularly, and generally live a healthier lifestyle starting now. Of course, these are all noble goals; unfortunately the hordes of people who will be back to their old ways by the end of the month far outnumber those who keep true to their intentions.

Perhaps the top reason that well-meaning “resolution-ers” fail is that the goals they set for themselves are unrealistic and set up to fail from the beginning. This year, instead of making over yourself, here are some tips to makeover your resolutions. This year, resolve to be successful!

Old resolution: I am going to lose weight—somehow. Making list of New Year's resolutions
People often will just set a weight-loss goal, but they don’t have a good plan on how to get there. Without a detailed plan, you’re likely to go back to previous eating and exercise patterns.
Makeover: Set a goal that is specific, measurable, realistic, and trackable. Walk for 15 minutes three times a week or add a serving each of fruits and vegetables. Focus on changes that you can make a part of your lifestyle seamlessly, so you’ll be able to sustain them for the long term.

Old resolution: That’s it, no more chocolate—ever!
Banning your favorite treat—whether it’s chocolate, soda, lattes, or french fries– is bound to backfire. Dieters often eat it, binge on it, feel bad, and then throw in the towel and revert back to their old eating patterns.
Makeover: Make peace with your trigger foods. Don’t have them at home staring you in the face, but allow yourself to have them once or twice a week.

Old resolution: Those holiday parties went straight to my hips. I’m going to have to starve
myself to undo the damage.
Too often when somebody says diet, they’re thinking deprivation. If your weight loss plan feels like a drag, you’re going to feel punished and abandon it.
Makeover: Rejoice in the lifelong health benefits you’ll be creating instead of getting down about dieting. Losing weight becomes easy when you invest your mental energy in making positive, healthy changes for yourself.

Drastic resolutions are simply not realistic. You’ll just get discouraged and give up. Instead, make some basic alterations to your lifestyle. These changes don’t all have to happen at once, but changes in what you eat, when you eat it, and how much you move your body will ultimately cause you to lose the weight. People who aren’t willing to change their lifestyle will never be successful with weight loss.

If you live in the Las Vegas area and are ready to change your lifestyle and do what it takes to finally be successful with weight loss, schedule an appointment with Dr, Shawn Tsuda. He and his expert team can help find the right treatment for you.